Unending pains in Malawi’s maternal health services


A cry in the bush! The baby is here, right in the middle of someone’s field.

That’s still the story of scores of women in Malawi such as Rhoda Graciano of Balaka who gave birth with the assistance of unskilled community members on her way to a health facility.

On this fateful night, she went into labour a week before her Expected Day of Delivery (EDD).


“The labour pains began at around six in the evening. But I thought I could make it to the next morning. I stayed many hours in labour with my first child, so I thought the same would happen to this pregnancy,” recalls Graciano, who gave birth in someone’s garden.

“I used to go to Namalolo Health Centre for antenatal care (ANC). I was advised to go to Balaka District Hospital before my EDD. But I couldn’t; I had no money for food and other requirements to be there on time,” says Graciano.

“Of course I was not the first person to deliver in this manner but I feel bad each time I remember the instance,” she laments.


Every Tuesday and Thursday morning, expectant women are all over Namalolo Health Centre.

The facility attends to 250 expectant mothers per month from Mwalabu and 26 other surrounding villages. It has a population catchment area of 31,000 people.

Most women begin ANC in their second or last trimesters of pregnancy. Only five percent go in their first trimester, says Annie Mtewa, nurse in charge of the facility.

She says most of these are aged between 15 and 18, an indication of early sex debut and marriages.

The fact that the facility has 250 women on ANC speaks volumes of how they religiously seek services health facility. Nevertheless their huge frustration comes when it is time to deliver their baby.

Group Village Head (GVH) Mwalabu tells that Namanolo Health Centre does not provide delivery services. As a result, at least 15 women (a month) deliver either at home or on their way to a health facility recommended for delivery services.

The picture of women like Graciano delivering on bare ground on their way to another health facility is stuck in the minds of many people of this area.

“A week hardly passes without being asked for transport for an expectant woman to go and deliver at either Kalembo Health Centre or Machinga District Hospital. Some even deliver right at my door step,” Mwalabu says.

The GVH says her village has by-laws that encourage women to go to a health facility three or four weeks before their EDD.

“If they fail, they are supposed to pay a penalty of K5, 000.

“I use the collections to pay for transportation of emergency labour cases. It’s however frustrating to note that despite the penalty, women are still not able to go to the facilities on time. They give excuses of long distance and poverty,” she says.

Mwalabu says women are required to take with them food stuffs and beddings when going to wait for their delivery, so this discourages them.

Users of Namalolo health facility are also fed up with watching street births. And now they are not idle. Foundation for Community Support Services (Focus) enlightened them through their Health Facility Advisory Committees (Hacs) that they need to play their part as a community.

Chairperson for Area Development Committee (ADC), Dennis Dziko, says in the last three months, the community has managed to mould more than 50, 000 bricks as they await for well-wishers to help in the construction of a maternity wing.

“This facility was built in 2004. The population is growing every day and this is demanding more services,” he says.

Dziko does not hide his embarrassment over inadequate maternity services at the facility.

“Our women are losing their dignity. They aren’t even welcome at Machinga District Hospital. They are ridiculed and told to go to Balaka hospital because they are from the district’s catchment area(s).

“But Balaka is far as compared to Machinga. The only other alternative is Kalembo health centre, whose distance is equal to that of Machinga hospital,” he says.

Communities surrounding Kwitanda Health Centre located in TA Nsamala’s area are in the same situation.

Their situation was nearly resolved. But disagreements erupted between the Ministry of Health and Village Reach, a local non-governmental organisation.

The NGO expressed interest to construct a maternity wing worth K36 million at Kwitanda Health Centre last year.

Hac vice chairperson, Rose Mwanyali, says the community satisfied its part of the deal by providing bricks and sand.

“Assessments were already done. Surprisingly, they came in early November informing us that they may not do the project. They were told that a standard maternity wing is supposed to cost a minimum of K200 million,” she says.

The facility serves a catchment population of 27, 230 from eight villages.

Women of Chimatilo and Chiyenda Usiku health centres are also dying for maternity services.

Chiyenda Usiku has an edge over the others because it is along Balaka-Liwonde tarmac road.

Hac chairperson for Chimatilo health post, Enock Mawecha, says Focus also encouraged them to make an initiative to have maternity services at the centre.

“We have 50,000 bricks. We are targeting to have 150,000 bricks by February 2017. We are hopeful that someone will come to our rescue,” he says.

TA Sawali says Chimatilo health post serves a population of about 18, 869 people and it would do the community good if they were to have maternity services.

“I feel so nervous when women are delivering at home or on their way to the hospital due to lack of maternity services at this place. As a woman in a leadership position, I will not rest until this facility has a fully operational maternity wing. This is a women’s dignity issue,” she says.


The TA says she is delighted that Hac and the youth are playing an active role in ensuring that the facility should have a maternity wing.

“The youths provided the bricks that we have. Even men of this community are fed up to have their wives, sisters, mothers delivering a baby on the ground or hear stories of maternal and neonatal deaths,” she says.

The Malawi Demographic and Health Survey (DHS) key indicators report of 2015/16 says access to proper medical attention and hygienic conditions during delivery can reduce the risk of complications and infections that may lead to death or serious illness for the mother and baby.

A large proportion of maternal and neonatal deaths occur during the first 48 hours after delivery. Thus, prompt postnatal care for both the mother and the child is important to treat any complications arising from the delivery, as well as to provide the mother with important information on how to care for herself and her child, reads the report.

Assistant professor at Institute of Health Metrics and Evaluation (IHME) Nicholas Kassebaum says in many nations, improvements in maternal health are accelerating, but in others women face daunting challenges including absence of trained professions to assist with pregnancy and child birth and to deal with life-threatening emergencies

“…Reproductive health care must be higher priority, including the expansion and improvement of reproductive health and family planning services,” he says in a media release on Global Health Indicators on 2016.

Monitoring and Evaluation Officer for Focus Vincent Ngwira says long distances to access maternal services remains a challenge due to lack of maternity wings at most health facilities in Balaka.

He says Focus aims at increasing community demand and participation in accountable and responsive maternal and child health service delivery.

The organisation is conducting the increasing citizen’s demand for accountability and transparency (IciDAnt) for maternal and child health project with technical support from Christian Aid and financial support from Scottish government.

“Focus expects communities to be empowered to demand quality maternal and child health care. Some communities have already been empowered and are actively holding duty bearers accountable for improved quality of services,” Ngwira says.

The World Health Organisation (WHO) says about 830 women die from pregnancy or childbirth-related complications around the world daily.

“Almost all of these deaths occurred in low-resource settings, and most could have been prevented,” says the WHO.

It says even though sub-Saharan African countries halved their levels of maternal mortality since 1990, maternal mortality is higher in women living in rural areas and among poorer communities.

Goal three of the United Nations Sustainable Development Goals (SDGs) states the need to ensure healthy lives and promote well-being for all at all ages.

One target under SDG three is to reduce the global maternal mortality ratio to less than 70 per 100 000 births, with no country (including Malawi) having a maternal mortality rate of more than twice the global average.

Facts about maternal mortality

– Daily 830 women die from preventable cases related to pregnancy and child birth world wide

– 99 per cent of all maternal deaths occur in developing countries

– Maternal mortality is higher in women living in rural areas and among poorer communities

– Skilled care before, during and after child birth can save the lives of women and new born babies

– Malawi mortality rate is at 634 per 100,000 live births

Source: WHO, DHS

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